Provider Demographics
NPI:1134279151
Name:KUPERSMITH, ADAM JAMES (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JAMES
Last Name:KUPERSMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1630 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-5210
Mailing Address - Country:US
Mailing Address - Phone:631-242-6166
Mailing Address - Fax:631-242-8768
Practice Address - Street 1:1630 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5210
Practice Address - Country:US
Practice Address - Phone:631-242-6166
Practice Address - Fax:631-242-8768
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY255202207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease